This study reviews the sedation combinations used in our intensive care unit (ICU) for pediatric bronchoscopic procedures. Sixty-four patients from ages 1 to 18 years were identified from the ICU database as having undergone fiberoptic bronchoscopy with bronchoalveolar lavage or transbronchial biopsy between June 1991 and December 1995. A retrospective chart review was performed on those patients. Medication dosages used for sedation were noted and an mg/kg dose was calculated. Also noted were the procedure duration and complications, including oxygen desaturation, bradycardia, and neuropsychologic complications. A total of 103 bronchoscopies were performed on 64 patients. Ketamine and midazolam were used in 42 procedures, while fentanyl and midazolam were used in 38. The remaining 23 procedures used other combinations. Seventy percent of the ketamine group received atropine before the procedure as an antisialogue. Major complications, including oxygen desaturation, stridor, cough, and nasal bleeding, were found in 13 patients. Twelve of these 13 complications occurred in patients treated with ketamine in some combination. Twelve of the 13 patients had HIV disease. Eight of the 13 children were 3 years old or younger. Although ketamine has been useful for amnesia and analgesia in pediatric procedures for many years, pediatric bronchoscopy, by virtue of its invasiveness on the pediatric airway and its impact on an already compromised lung, may be an exception to ketamine's safety profile. Its use, especially in the smaller airway, may need to be reconsidered and should be evaluated prospectively. An abstract to this effect will be submitted to the 1997 Society of Critical Care Medicine annual symposium.